Parkinsonian gait in elderly people: Significance of the threshold value of two and more falls per year

• Published in: Revue neurologique Vol. 177; no. 4; pp. 385 - 393
• Main Authors: Kiesmann, M., Sauleau, E., Perisse, J., Jehl, C., Konrad, S., Karcher, P., Fleury, M.C., Rohmer, D., Sauer, A., Ehret, M., Vogel, T., Kaltenbach, G., Schmitt, E.
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01-04-2021; Elsevier Masson
• Subjects: Computer Science; Elderly persons; Falls; Fluctuating cognition; Gait disorder; Image Processing; Parkinson's disease; Gait disorder; Falls; Parkinson's disease; Elderly persons; Fluctuating cognition
• ISSN: 0035-3787
• DOI: 10.1016/j.neurol.2020.06.012

Parkinsonism in the elderly presents a major risk factor for recurrent falls (2 and more falls per year), which is associated with increased morbidity. The main objective was to investigate explanatory variables relating to the risk of being recurrent fallers (RF) in persons with parkinsonian gait.
Seventy-nine among 172 eligible persons were enrolled in this prospective study, the findings of which were analyzed at 12 months. Motor and non-motor features, as well as follow-up interviews to identify falls, loss of ability to walk, fluctuating cognition, traumatic falls, all-cause hospitalizations and deaths were collated and results compared between non RF (zero and one fall per year) and RF. Bayesian model averaging was used to predict the probability of patients being RF from their medical history as well as from cognitive assessment, gait velocity, vision and posture.
N=79, 0.58 men, 50% had Parkinson's disease, 14% other neurodegenerative parkinsonian syndrome, 23% vascular parkinsonism and 13% Lewy body disease, 58% were RF. Median age 81.2 years and median MMSE 25/30. A history of falls and of hallucinations, median odds ratio respectively 9.06 (CI 2.34–38.22), 4.21 (CI 1.04–18.67) were associated with the highest odds ratios along with fluctuating cognition and abnormal posture. Two or more falls a year was a relevant threshold to distinguish a population with a high risk of comorbidity.
The whole history of falls, hallucinations and fluctuating cognition can be considered predictive of recurrent falls in elderly people with parkinsonian gait and provide a tracking tool for patient management.